Chapter 122 - Peritonitis Flashcards
What is the postulated mechanism for primary peritonitis?
Hematogenous dissemination of infectious agents
Likely facilitated by impaired host immune defenses
If a cat is diagnosed with primary peritonitis with Bacteroides and Fusobacterium spp., what is the likely source?
Translocation from the oral cavity (unrecognized direct
penetration (bites) or a hematogenous route)
What is the most common cause of secondary peritonitis?
Contamination from the GI tract (ulceration, foreign body obstruction, neoplasia, trauma, ischemic damage, or dehiscence of a previous surgical incision.)
Below which serum albumin concentration hypoalbuminemia becomes a risk factor for septic peritonitis after GI surgery?
< 2.5 g/dL
T/F: tachycardia and hypothermia are negative prognostic factors in cats with septic abdomen
F: bradycardia and hypothermia
How does the concurrent presence of pleural effusion affect the prognosis of peritonitis?
The presence of bicavitary effusion increased the mortality rate of patients 3.3-fold compared with that of patients with peritoneal effusions alone
What differences between glucose and lactate serum concentration and peritoneal concentration are suggestive of bacterial peritonitis?
Glucose: difference of > 20 mg/dL
Lactate: difference of > 2 mmol/L
In which situations, differences between glucose and lactate serum concentration and peritoneal concentration are unreliable to diagnose a septic peritonitis?
- In case of hemoabdomen
- In case of dextrose administration
- Postoperative cases in which closed suction drains have been placed
What ratios of peritoneal:serum concentration of potassium and creatinine are suggestive of a uroabdomen?
- Peritoneal:serum creatinine more than 2 : 1
- Peritoneal:serum potassium concentration more than 1.4 : 1
What are common bacteria isolated from a septic abdomen?
Escherichia coli, Clostridium spp., and Enterococcus spp. are common isolates.
What suture material is advocated in animals with septic abdomen?
Monofilament resorbable
Why is it recommended to preserve as much omentum as possible for the surgical treatment of a septic abdomen?
- To promote venous and lymphatic drainage from the peritoneal cavity.
- Immunogenic, angiogenic, and adhesive properties.
What are the risks of an open abdominal drainage of peritonitis?
- Susceptibility to superinfection with nosocomial bacteria
- Massive fluid and protein losses
Is the vacuum-assisted peritoneal drainage placed over the cranial or caudal aspect of the abdominal incision?
Cranial (1/3 to 2/3)
What are poor prognostic factors for animals with septic abdomen?
- Refractory hypotension, cardiovascular collapse, disseminated intravascular coagulation, and respiratory disease
- The combination of hypothermia and bradycardia in cats
Define peritonitis.
Inflammation of the peritoneal cavity, classified by underlying cause (primary vs secondary), extent (local or generalized) or presence of infectious agents (septic vs non-septic)
What is primary peritonitis?
Spontaneous inflammatory condition in the absence of underlying intra-abdominal pathology or known history of penetrating peritoneal injury
What is one proposed mechanism of primary peritonitis?
Hematogenous dissemination
Common example of primary peritonitis?
FIP, Salmonella typhirium, Clamydia pssitaci, Clostridium limosum, Mesocestoides spp, Candida, Bacteroides, Actinomyces, Blasto
T/F: Secondary peritonitis is usually identified as a septic cause.
True
What was found to be the underlying pathology in 25% of cats with septic peritonitis secondary to GI leakage?
Neoplasia (lymphoma and adenocarcinoma)
What conditions increased the risk for leakage after intestinal anastamosis in dog?
Perioperative peritonitis, intestinal FB, serum albumin <2.5 (also intra-op hypotension)
T/F: Bradycardia and hypothermia in cats with primary septic peritonitis has been established as a negative prognostic indicator.
True
When does dehisence typically occur after surgery?
3-5d
What should be performed when peritonitis is suspected despite the absence of detectable effusion or when a minimal volume of effusion makes it difficult to obtain a sample?
Diagnostic peritoneal lavage (Catheter into abdomen, infusion of 22ml/kg warm sterile isotonic saline and then getting a sample for analysis, C/S)
A concentration of what between paired samples for blood and peritoneal glucose is a reliable predictor of a bacterial peritonitis.
20mg/dL
T/F Abdominal fluid lactate concentration of greater than 2.0mmol/L is predictive of septic peritonitis in a patient with a closed suction drain.
False, less than 2.0mmol/L
Diagnosis of a uroperitoneum can be made if the peritoneal fluid creatinine or K concentration exceeds that of the serum by what?
Creatinine 2:1
K 1.4:1
T/F: Placement of nonabsorbable suture material can be used within the abdominal cavity with septic peritonitis.
False, can serve as a nidus for infection
T/F: If debridement and lavage can resolve gross foreign material or GI spillage and the source of contamination can be controlled, the abdomen should be closed primarily.
True
What is the goal of blood component therapy in stabilizing patients with peritonitis (PCV, serum protein, COP)?
PCV >20-25%, serum protein >3.5g/dL, COP >16 mmHg
What are some poor prognostic indicators for patients with septic peritonitis?
Refractory hypotension, cardiovascular collapse, DIC and respiratory disease
